Psychiatrist in Pune , Dr Neville Misquitta (MD Psychiatry). This is a psychiatrists take on Pune occurrences. Mental health issues reflect underlying universal problems that keep some of us from a meaningful life. At Pathfinder Clinic we make the link.

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Saturday, January 13, 2018

Effect of Anger on your Child

Anger has a silent but permanent effect on your child. Anger can affect your professional life, harm relationships, and has significant health implications. But quite apart from how it affects you personally, it affects your children. Children of angry adults have been seen to be more aggressive, oppositional and non-compliant. They are also less empathetic; and display poor overall social adjustment. Delinquency and anti-social behaviour are also more common in such children.

Is anger hereditary or learned?

A child experiences emotions from birth, but how he/she handles emotions is largely determined by learning. While a child may have an irritable temperament, no child is born with temper tantrums. A child learns that throwing a temper tantrum is rewarding (gets attention or gets him what he wants).

From infancy onward, children learn by imitation. As parents, we are the first role models. Our children watch us; and then model their behaviour on ours. A child will for example; notice that we talk to our elders respectfully, but that we talk brusquely, even rudely to our maids. They will soon behave the same way.So it is with anger. Children observe how we react in difficult situations, how we react to provocation; how we deal with differences. Do we negotiate and listen to the other person’s point of view? Or do we react immediately and aggressively? Do we talk amicably and or do we get what we want by threats and abuses? How we behave and act today is what our children will emulate tomorrow.

What is the effect on a child when adults behave angrily in front of them? It depends a great deal on the age, developmental stage, personality and emotional maturity of the child.

Young children, particularly, are scared and confused when they see adults who are ‘out of control’. When it happens often, they learn to think of this behaviour as ‘normal’; and they assume that verbal or physical aggression is the ‘normal’ way to deal with differences, to control others, or get what one wants.

Very often, children are at the receiving end of parental anger. This may be due to unfair and unrealistic expectations that parents have from their children; or misplaced anger that has its basis somewhere else. Fear, insecurity, and poor self-esteem occur almost universally. Withdrawal, anxiety, depression are some of the negative consequences of such anger. This affects optimal performance in school and peer relationships.

Alternatively, the child may learn to defend itself by increasingly oppositional behaviour, bullying younger siblings or other children, or engage in other disruptive behaviours –truancy, aggression and violence.

Parental anger deprives children of the basic need for security and comfort in their own homes. It also perpetuates the legacy of anger and aggression; conflict and fear.

Anger management strategies for interacting with children

Stay calm when interacting with children. If you are fuming because you were held up in a traffic jam, cool off with a shower before interacting with your child.

Physical abuse is a strict no.

Try and understand the underlying issues behind your anger. Is your frustration resulting from an unsatisfactory day at work? Is your disappointment with your child’s academic performance related to your own expectations?

Learn about your child—his needs, his temperament, learning styles, even the normal development process. This will go a long way in modifying your unreal expectations.

It is possible to break the destructive chain of anger and to create an environment of safety and security in your home for your children. Start today.

Friday, January 20, 2017

Forgetfulness and Memory Loss

Forgetfulness or failure to remember information, is a common complaint. All of us have at some time or the other forgotten to make that important call, to pick up some items from the store, an anniversary or birthday, or a colleague’s name. Students forget what they have “learnt” during exams. We often can’t remember where we have left our car keys, our wallet or that important document. Is it normal? And more importantly; when do we need to seek help?

Forgetfulness or memory loss and difficulty concentrating are common symptoms of mental health disorders. This is specially so in depression, anxiety disorders, ADHD (Attention Deficit Hyperactivity Disorder), and dementias as shown in the examples below.

A young working professional seeks help for increased forgetfulness and poor ability to focus at work. Further probing reveals decreased interest in doing things at work and home. She is also irritable, depressed and her sleep is disturbed. These symptoms of low mood can exist in the background of memory loss and problems with focus.

A student during exams has high anxiety causing memory loss. She cannot recall the answer to a certain question. She gets nervous. This causes her to make mistakes in the next question. She tends to panic; fail to recall what she studied. This vicious cycle is common in anxiety disorders and can manifest as problems with concentration, memory and forgetfulness.

An older person does not just forget the name of his neighbour (something that may happen to any of us); but also who she is. He has problems using money, and with shopping. Difficulties at work manifest towards the end of the career. Dementias affect the aged; cause memory loss and affect the context of the memory.

A young professional has problems organising and completing projects at work. There may be a history of attention and academic problems in school. Working memory gaps are common in this group. ADHD is a common cause of this problem in adults.

Memory Processing in the Brain

To understand further, it helps to know in brief how memory works. It is a 3 stage process

Encoding

The stage when sounds, images and other sensations are given meaning is called encoding. Sensations are coded electrically for access by other brain areas. (We hear a catchy song from a new movie).

Storage

The process of association or tagging the input with other bits of data to make it persist. The song thus gets stored in our long term memory. Initially, the song remains for a very short while. At this point it is in our working or short term memory. It is encoded. However, we forget the song as the next scene unfolds on screen. The song is repeated at the end of the movie; someone hums the song as we leave the hall. The visuals of the song, and the feelings evoked, the fact that it was a famous actor, then reinforce the memory and makes it persist.

Retrieval

When we need to use this stored data, the brain fishes it out from its long term memory. The more the associations or tags we formed earlier, the more easily the brain can access the information.

Problems in memory can therefore occur at any of these stages. Many of these occur at the stage of encoding because we are simply not paying attention; and many other distractions are vying for our focus at the same time. (e.g checking our FB messages while studying). The brain does not multi-task, it can only do one thing at a time.

Repetition, rehearsal and organisation help in fixing and storage of long term memory. The more widespread and elaborate the connections, and the more data available about an input, the more the connections formed by the brain, and the easier it is for the brain to retrieve the information when required. Many cases of forgetting are due to retrieval failures. The information is there in long term memory but we are unable to access it. This is why we can recall certain things at a later date.

Depression affects memory in many ways. Being unable to concentrate is a symptom of depression. Repeated depressive thoughts also block the learning process through distraction. This affects the stage of encoding. Disturbed sleep which is a common symptom in depression hampers fixing into long term memory.Forgetfulness is common in ADHD of adults. ADHD lowers the power to focus. The person is easily distracted. The attention span is reduced. This impairs short term or working memory. ADHD persists in up to 40% of aduts.Anxiety gives rise to pointless thoughts (“my father will be so angry if I don't crack this exam”) which frustrates attempts to retrieve the matter learned. The anxiety provoking thoughts distract from the text which is being studied and impedes the encoding process.In dementia there is destruction and loss of brain cells. Dementia blocks all stages of the memory and learning process. The process is not reversible.

Forgetfulness and Memory Loss – when to seek help?

When it affects our work, or the quality of our work

When the failure to learn and recall affects our daily activities and functioning

When there are also problems including sleep, appetite, inter-personal or behaviour changes.

When it is strange - leaving keys in the fridge

When it can harm - often leaving cooking burner on, leaving doors unlocked at night

In normal forgetfulness, the person may recall the memory when some cues are given. The memories were encoded, they just needed some reminder to access them. In clinical disorders resulting in memory loss the memories were never laid down in the first place, or the storage structures in the brain are destroyed. Access to these memories may not be possible.

Sunday, February 20, 2011

Effective study skills are essential learning habits for students. Some students have a knack of learning much in a short time. Others study for hours without much progress. An important differentiating factor is the method of study. Effective study habits can be learned (Barry L. Richardson and Murray Saffran 1985, D F Alexander 1985). The good student must not rely on “study drugs” as these are associated with addiction, panic reactions, confusion, and medical complications including heart attack and stroke (Steve Sussman and colleagues, 2006).

Habit No 1: Apply book learning to daily life

Those who learn rapidly apply their imagination freely to their studies. They see that every subject of study deals with something vital in the affairs of the world, and probably of personal relevance.Allow the knowledge you are acquiring to become an active part of your daily life, with some bearing on normal activities. Thinking about studies in this way will help build greater interest and also help you to understand and remember things better.

Habit No 2: Think of the long term reasons for studying

Imagine yourself as the CEO in a multinational company; as an internationally acclaimed designer; as an architect creating the perfect city, as the next software entrepreneur, or picture yourself as the valued management expert. Hold that image in your mind and add some detail to it every day.Visualising these ultimate goals, will give you fresh energy to keep going, because whatever your dreams; your studies are a necessary step towards achieving them.Many students don’t know what they want to do after their board or other graduation exams. I’ve found Aptitude Testing to be a great way to get them thinking and motivate them to study. Parents usually get this done after the exams. Aptitude assessment before the exams has the added advantages of motivation for study, as also reducing anxiety related to making career choices.

Habit No 3: Organise your work

Successful study is largely a matter of good organisation.

Establish a regular routine. As far as possible study at the same time and place each day. A quiet, well-lit room, free from distractions is best.

Work out a daily timetable, to guide your activities. Do not be over ambitious with your timetable. Keep it flexible and do not try to learn more than you can comfortably manage.

Begin your major assignments well in advance of the required finishing dates to avoid having to complete them in a rush.

Habit No 4: Follow good study technique

Effective learning habits also minimise test anxiety.Make notes and underline key sentences. Notes should be brief and to the point. Let notes assist your memory, not replace it.Concentration is a necessary study habit. Resolve, for instance, to study ten pages without a break and then relax. Break up the learning of a lengthy item into sections, concentrating on each separately.Start at the appointed time everyday. Do not make excuses – ‘I have to get into the right mood’; ‘I’ll just watch TV for 5 more minutes’. Just plunge into your work.

Habit No 5: Enhance your Memory

Memory depends on association, attention and repetition.

Association can be developed by deliberately setting out to form associations or links with given words or facts.

Attention is necessary for registration in the mind. Attention comes from interest in the subject, exercising the brain on it, and by focusing on one’s work in as much detail as possible.

Interest can be inculcated. The more you know about something, the more interesting it becomes.

Develop understanding. It is easier to remember something that is clearly understood. Aids to understanding include a wide vocabulary, good command of language, wide reading and plenty of discussion.

Repetition helps in fixing memory. It is most effective if interest and understanding are involved.

Habit No 6: Build a positive attitude

Think positively. Do not picture defeat, or failure. Use your imagination to dwell upon the positive aspects of life - happiness, hard work, success, health.People who succeed in examinations begin by believing that they will succeed. Keep telling yourself you are certain to be successful when you do the required work.Examinations are designed for the average student to pass and the outstanding student to get a distinction.

Sunday, January 23, 2011

Pune students need to differentiate true exam stress or test anxiety from rational test anxiety that occurs due to a lack of adequate preparation. Both conditions need to be addressed differently. True test anxiety is diagnosed when the student panics, "blanks out", or overreacts despite the following (Hanoski 2008):

Exercise - the amount can be varied. Incorporate some stretching exercises and some aerobics like skipping or same place jogging.

Relaxation - use a muscle relaxation technique or any form of meditation that doesn't take more than a few minutes

Sleep hygiene - for adequate, predictable and refreshing sleep

Cognitive and emotional measures

Cognitive restructuring - see the exam as a means not an end. Keep in mind the ultimate goal you are working towards. This goal may differ from those of your parents and school. Aptitude testing, career guidance and counselling help match your expectations and capabilities with that of your family and school.

Stress inoculation - take regular mock exams under the same conditions as the actual test

Attention to practical aspects of the exam

Find out where the test is scheduled to take place and how long it will take to get there

Look at the buildingso that it feels more familiar.

Know the rules as to what can be taken into the exam room etc [28].

The Day of the Test

Begin the day with a moderate breakfast, avoid coffee

Do something relaxing the hour before the test

Plan to arrive at the test location early

Avoid classmates who generate anxiety

During the Test

There are basic test taking strategies and specific anxiety management techniques that the student needs to learn (Hinton and Casey 2006).Before answering

Review the entire test and then read the directions twice.

Think of the test as an opportunity to show what you know then begin to organise time efficiently.

Focusing exercise

Take a deep breath. Look straight ahead at something inanimate (the wall, a picture, the clock)

Focus the mind on the positive thought 'I CAN DO this exam' while breathing out.

Do the easiest parts first

For essay questions start by constructing an outline.

For short-answer questions answer exactly what is asked.

If there is difficulty with an item involving a written response show some knowledge.

If proper terminology evades you show what you know with your own words.

For multiple choice questions read all the options first, then eliminate the most obvious. If unsure of the correct response rely on first impressions, then move on quickly. Be careful of qualifying words such as "only," "always," or "most."

Stick to time

Do not rush through the test.

Wear a watch and check it frequently

If it appears you will be unable to finish the entire test, concentrate on parts you can answer well.

Recheck your answers only if you have extra time - and only if you are not anxious.

Learn a few of these techniques and stick to the ones that suit you. Use them whenever you panic while studying or during the exam. If problems persist despite using these techniques there are safe and effective medications that can be used just prior to the exam.Thought-stopping

Halt the spiralling thoughts by mentally shouting 'STOP!' Or picture a road STOP sign, or traffic lights on red.

Once the thoughts are stopped continue planning, or practise a relaxation technique.

Mild pain

Pain effectively overrides all other thoughts and impulses.

Lightly press your fingernails into your palm

Place an elastic band around your wrist and snap it lightly

Use a mantra

A mantra is a self-repeated word or phrase.

Repeatedly say 'calm' or 'relax' your breath

Distraction

Distract attention from anxious thoughts and keep your mind busy

Look out of the window, count the number of people with spectacles

Count the number of desks in each row

Make words out of another word or title

Bridging objects

Carry something having positive associations with another person or place

Touching the bridging object is comforting

Allow a few minutes to think about the person

Self-talk

In exam anxiety or panic there are often negative messages, 'I can't do this' 'I'm going to fail' 'I'm useless'. Consciously replace these with pre-rehearsed positive, encouraging thoughts:

'This is just anxiety, it can't harm me',

'Relax, concentrate, it's will be OK',

'I'm getting there, nearly over'.

After the Test

Whatever the result of the test, follow through on a promised reward - and enjoy it!

Try not to dwell on all the mistakes.

Do not immediately begin studying for the next test. Do something relaxing for a while! (University of Illinois 2007).

Exam stress in students requires active management. State boards are taking exam anxiety and its adverse fallout seriously. The Central Board of Secondary Education (CBSE) has brought out a handbook, Knowing Children Better, offering information and advice on handling exam stress. When problems persist students and parents should not hesitate to seek psychiatric help (Malhotra 2007).